More than half a year into the coronavirus pandemic, how are you sleeping? Are you up at night worrying about work, finances, family schedules, all of the above? Are you staying up late to take care of all the stuff you can’t get done during the day because of changes to your kids’ school schedules? Are you feeling isolated from friends, colleagues, extended family?

These are unprecedented times, with unprecedented challenges that are creating unprecedented stress and widespread problems for sleep. We’re learning more all the time about the impact of the pandemic on sleep and emotional health. It feels like the right time to check in about the latest science on how sleep is being affected, and what you can do to get your best rest during these stressful days and nights.

Short-term insomnia rates soared at the start of the outbreak. Now chronic insomnia is likely soaring, too

Acute insomnia is a sudden onset of insomnia symptoms, usually in response to a disruptive, stressful life event. Short-term insomnia happens throughout our individual lives. A job loss, a relationship strain, an illness in the family—something unexpected happens and suddenly you can’t sleep. There’s scientific evidence that large-scale events—things like earthquakes and wildfires–create spikes in acute, or short-term, insomnia in affected populations. For the first time in our lifetimes, the large-scale crisis that’s unfolding is happening to everyone around the world.

A number of studies found high rates of insomnia in response to the early days and weeks of the pandemic, including this large-scale study in China, which found that at least 20% of participants met a clinical diagnosis of insomnia. When scientists compared pandemic insomnia rates to pre-pandemic rates, they found the prevalence of clinical insomnia had increased by 37%.

Under any circumstances, acute insomnia often evolves into chronic insomnia. Acute insomnia typically resolves over a period of days or weeks. Chronic insomnia lasts for 3 months or more, with insomnia symptoms appearing several nights a week, week after week. Estimates suggest that roughly 50% of people with insomnia experience symptoms for a year or more.

Chronic insomnia raises risks for long-term health and functioning, including heart disease, metabolic disorders including diabetes, as well as depression and cognitive decline. I wrote recently about the links between disrupted sleep and Alzheimer’s disease.

Given the ongoing stress and upheaval that most people are facing several months into the pandemic, I expect that many cases of acute insomnia are now chronic.

WHAT TO DO: It’s time to take a careful, honest look at your sleep. Most of us experienced a series of sleep-deprived nights in the early days of the pandemic. If your sleep is still disrupted, if you’re routinely having trouble falling asleep, staying asleep, if you’re waking early and feeling unrefreshed by your sleep, you’re experiencing the symptoms of chronic insomnia.

Acknowledging your sleep issues is the first critical step to improving your long-term health. There are a range of treatments for chronic insomnia, including cognitive-behavioral therapy that’s specifically designed for insomnia, as well as natural supplements, mind-body awareness practices, and modifications to sleep routines and sleep hygiene habits. Identifying any underlying medical conditions that may be affecting your sleep—and any potentially sleep-disrupting side effects of medications you’re taking—is also an important step.

These are  5 of the most common contributors to insomnia.

Discuss your symptoms with your doctor to determine the right course of therapy for your individual sleep issues. I always encourage people to seek the expertise of sleep specialists—here’s an American Academy of Sleep Medicine directory where you can find one.

Clinicians, educators, community leaders: we need more public health work that specifically addresses the sleep disruptions occurring in the pandemic. Don’t wait for someone else to do it—get organized to educate and support your community about the importance of tending to sleep.

Proximity to ‘hot spots’ affects the severity of sleep problems and psychological stress

Research has found that the severity of both insomnia and psychological distress during the pandemic are closely tied to individuals’ proximity to coronavirus outbreaks. Proximity here means a few different things:

Location. Being closer to the geographical site of a severe outbreak can heighten both sleep issues and trigger more anxiety, stress and depression.

Degree of exposure and threat. Essential workers and people working in place where outbreaks are more likely to occur are also at greater risk for sleep disruption and psychological distress. That’s everyone from health care workers, to people working in places such as nursing homes, manufacturing sites, even schools and universities. And the perception of threat is likely just as significant to sleep and stress as the actual, statistical measurement of risk for people who are working in places where groups congregate.

With pandemic hot spots shifting around the US and the world, different regional populations with experience different levels of exposure at different times, with shifting risks for sleep problems.

WHAT TO DO: Be prepared to respond to changing circumstances. We talk about emergency preparedness in terms of evacuation plans, go-bags, stores of supplies, plans to meet family in a designated space, plans to care for and transport pets in an emergency. These days, we all need an emergency preparedness plan for sleep. That includes:

Supplies of any supplements or medications you’re using for sleep and psychological health. I’ve written extensively on supplements and natural remedies for sleep, from melatonin to magnesium to cannabis. Here’s also a rundown of some of the most effective natural supplements for sleep, including melatonin, magnesium, and CBD. Important: Always consult your doctor before beginning a new supplement routine.

A sleep-focused game plan for when life gets turned upside down. Many readers have already lived through severe coronavirus outbreaks in their local regions, while others are living through it now. Still others may have a relatively low presence of coronavirus in their local area, but that may change in the coming months. We all need to develop plans for how we’ll protect our sleep if and when daily routines change again suddenly. We can’t predict exactly what that will look like, but we have a pretty good idea: schools shift to remote or reduce in-person hours, exposure to someone who’s sick means your family has to quarantine, stricter physical distancing measures means you can’t engage in your normal exercise regimen.

Take time NOW to plan for an altered routine that includes sufficient time for sleep. Set aside time for work, schooling, and household stuff around sleep—not when you would otherwise be sleeping. It’s a tall order, but your rest is fuel for your health, ability to function and maintain psychological health through this ongoing challenge.

I wrote in the spring about how each chronotype can use their individual preferences to create routines that support sleep, productivity, and emotional balance during these challenging times. This advice is just as relevant now as it was back then!

Social isolation is a BIG challenge for sleep and mental health

We don’t talk enough about the impact of social isolation—and the loneliness it can create—on sleep. Right now, so many of us are living at a distance from the in-person social networks that provide us with support, comfort, fun, and a sense of connection that’s both enlivening and calming.

I’ve written before about the impact of social isolation and loneliness on sleep. Even before the pandemic, levels of loneliness in the general population were alarmingly high and growing, with nearly one-half of US adults regularly feeling isolated and alone.

Scientific research shows that loneliness hurts sleep quality and sleep quantity. Research also shows that the quality (not the quantity) of our friendships predict how well we sleep. And recent research from the University of California, Berkeley shows that in turn, lack of sleep heightens feelings of loneliness and isolation.

WHAT TO DO: Use this 2-way street between sleep and social isolation to your advantage. Prioritizing sleep will help ease the psychological burden of the social distancing and isolation you’re living with. And finding ways to engage with people who provide you with a sense of connection will help you sleep better.

That can mean all sorts of things—having a quiet dinner with your partner, taking a long walk with a friend, reaching out virtually to people who “get you,” who make you feel good and make you laugh. Join a support group—virtual support groups are everywhere these days, for parents, seniors, health care workers, for people feeling the emotional strain of this prolonged period of social distancing. Get involved with helping others. Remote and safe in-person volunteer work can provide you with a powerful sense of connection.

Your sleep WILL improve when you strengthen your social ties.

Our Chronotypes may be chronically out of sync

Circadian rhythms regulate sleep-wake cycles, as well as most of the body’s important processes, including hormone production, immune system activity, appetite and metabolism, cognitive functioning. Our internal clocks serve as very precise timekeepers of all this biological activity, to keep us functioning normally. Even small disruptions to the timing of circadian rhythms can create significant problems for sleep, mood, health and productivity. And biological clocks are affected by the same processes they regulate, including sleeping and eating.

The pandemic has thrown daily schedules out of whack and introduced a number of new challenges for circadian clocks. We’re still spending way more time at home than is normal for most of us, and work and school schedules are less fixed and predictable. For many of us, sleep and wake times have changed, and are less consistent. Plenty of us are getting less sunlight, and more exposure to artificial light at night. Eating routines may have changed, with a tendency to eat later in the day that many people may be experiencing. We may be getting less exercise.

Ideally, our daily routines align with and reinforce our chronotype—when we work, when we rest, when we eat and exercise, when we play and have fun. (I wrote a whole book about this, The Power of When.) Disruptions to our daily routines have been both significant and prolonged, and disruptions to circadian clocks—commonplace before the pandemic—are now likely even more widespread and severe.

Research coming in has shown that during the pandemic, bedtimes and waketimes have shifted to later hours, and that people are using more digital media at night before bed, increasing sleep-disruptive nighttime light exposure, which will further shift the timing of our biological clocks.

Chronotypes that are out of sync negatively affect sleep routines, mood, energy levels, our ability to be productive. And there are long-term risks to health, including elevated risks for  cardiovascular and metabolic diseases, cancer, obesity, and neurodegenerative disease.

WHAT TO DO: Reclaim a schedule that aligns with your chronotype. It may not look like the one you had before the pandemic. But if you’re working in alignment with your individual chronotype and being consistent about sticking to routines for sleep and activity, you are doing great, important work on behalf of your mental health, your sleep, and your overall health.

If you haven’t already, start by determining your chronotype, by taking this short quiz: www.chronoquiz.com. And here’s a primer I wrote earlier this year on how to use your chronotype to set up healthy routines during the pandemic. Most of us have fewer external guideposts providing structure to our daily lives. To improve sleep and protect mood and physical health, it’s essential we take the initiative to create routines we can stick with.

Psychological distress has soared during the pandemic—and it’s hurting sleep

A number of studies conducted during the pandemic have delivered similar, unsurprising news: stress, anxiety, depression and other forms of psychological distress have spiked. Research from the earliest days of the pandemic in China showed that more than 18% of the population was experiencing clinical levels of anxiety, and nearly 25% had depression. Other research from China and elsewhere around the world has returned similar results, in some cases showing significantly higher levels of generalized anxiety—and a strong connection between anxiety levels and time spent focusing on the coronavirus outbreak.

An analysis of research that’s investigated depression, anxiety, and stress in the pandemic found that each may be present in about a third of the general population. Among health-care workers, rates of anxiety, stress and depression are even higher, with about 45% experiencing anxiety and about 50% experiencing depression symptoms.

The implications here for sleep and health are profound. There is a close, bi-directional relationship between stress and mood disorders and sleep problems. Psychological distress also weakens the immune system, disrupts circadian rhythms, and raises risks for other psychological conditions including PTSD, ADHD, panic attacks and suicide.

WHAT TO DO: Don’t suffer silently. And don’t try to tough it out through chronic stress, anxiety, or feelings of depression, overwhelm, or hopelessness. Recognize that your sleep and your psychological health are connected, and that addressing any sleep issues you’re having is one way to improve and protect your mental health, in the short and long term.

Recognize also that improving sleep on its own may not be enough to restore emotional and psychological balance and well being. And the presence of anxiety, depression, and/or chronic stress may make it difficult to achieve significant improvements to your sleep. Cognitive behavioral therapy and other forms of psychotherapy—all available through telehealth and other virtual platforms—are a wise and important step to take. Waiting to seek out therapeutic help will only make sleep and psychological problems worse.

If you are having thoughts of suicide, know that you are not alone. If you or someone you know needs help, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text 741-741 for the Crisis Text Line. If you are in danger of acting on suicidal thoughts, call 911.

We’re in a long-haul journey through this pandemic, learning together, in real time, its effects on sleep and psychological health. We’ll get through by supporting each other, by learning all we can about the challenges we’re facing to sleep and mental health, and by putting that research-based knowledge into constructive action to improve our daily routines and seek out the medical and therapeutic support we need to stay rested and well, physically and emotionally.

Sweet Dreams,

Michael J. Breus, PhD, DABSM

The Sleep Doctor™

www.thesleepdoctor.com